Are Steroids Always Necessary in Multisystem Inflammatory Syndrome in Children (MIS-C)?

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) treatment is still under debate and involves Intravenous Immunoglobulins (IVIG) and/or steroids. We retrospectively analysed data from the patients admitted to Our Institution during the year 2020 to investigate whether prompt IVIG treatment conditions cardiac dysfunction and need for support and if addition of steroids in different doses correlates with outcomes. Days of fever, time between fever appearance and IVIG treatment, left ventricular ejection fraction (LVEF%) at admission and Cardiac Function Recovery Time (time between worst LVEF and resume of LVEF >55%) were used as outcomes. 38 patients were admitted with MIS-C. All except one received IVIG; 24 received also different Methylprednisolone dosages. Time to IVIG treatment, adjusted for age and sex, correlated with global duration of fever (Coefficient: 1.2; 95% CI:0.73-1.68) and with Vasoactive Inotropic Score (VIS) (Coefficient: 0.09; 95% CI 0.02-0.15), with pericardial effusion (Coefficient: 2.37; 95% CI: 0.45-4.2). Global duration of fever was associated with time to IVIG (Coefficient: 0.8; 95% CI :0.49-1.13) and positive Covid-19 swab (Coefficient: 1.71; 95% CI 0.21-3.22). Cardiac Function Recovery Time did not show differences with different steroid dose regimens. High-dose steroids did not show any benefit in our cohort.